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PubMedDate not supplied

Evaluation of the severity of traumatic rhabdomyolysis using technetium-99m pyrophosphate scintigraphy.

A quantitative scoring method was designed to assess the extent of muscle damage. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy was performed for 9 patients experiencing crush injury in the Chichi (Taiwan) earthquake. The magnitude of muscle uptake of 99mTc-PYP was graded as follows: grade 0, less than bone radioactivity (BRA); grade 1, equal to BRA; grade 2, higher than BRA; or grade 3, greatly higher than BRA. The area of muscle injury was estimated according to the rule of nines. The sum of the muscle injury size multiplied by its corresponding grading was defined as the anterior or posterior score according to the anterior or posterior images. Each image was interpreted by two physicians and average anterior and posterior scores were calculated. The muscle score was defined as the geometric mean of the average anterior and posterior scores. Significant correlations were obtained between the muscle score and duration of time trapped (r = 0.868, p < 0.01), peak serum creatine kinase level (r = 0.866, p < 0.01), peak serum phosphorus level (r = 0.877, p < 0.01) and number of hospital days (r = 0.875, p < 0.01). A negative correlation between the muscle score and blood pH (r = -0.706, p < 0.01) was also observed. We concluded that this scoring method may be used as an adjunct for evaluating the locations of trauma and the severity of crush syndrome, and for predicting the duration of hospital stay.

Adolescent↗
PubMed2002

Increased lung uptake of technetium-99m hexamethylpropylene amine oxime in systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE) can affect every organ. Involvement of the lungs in this disease is a significant cause of morbidity and mortality. OBJECTIVES: To assess pulmonary vascular endothelium damage in SLE by lung uptake of technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO). METHODS: Lung uptake of (99m)Tc-HMPAO was measured in 20 SLE patients and for comparison in 25 controls without SLE, referred for brain imaging due to dementia or stroke. Of the 20 SLE patients, 10 had significant clinical pulmonary manifestations. However, all SLE patients had normal chest X-ray findings. Anterior lung image, including a large part of the liver, was taken 10 min after intravenous injection of 20-25 mCi of (99m)Tc-HMPAO. Regions of interest were calculated over the liver and lung. RESULTS: The mean lung/liver uptake ratio in patients without SLE was 0.36 +/- 0.1. The mean lung/liver uptake ratio in SLE patients was 0.79 +/- 0.58. The difference was significant. CONCLUSIONS: Our results indicated that determining the ratio of lung/liver uptake of (99m)Tc-HMPAO may be a useful complementary method to assess pulmonary injury in SLE patients.

Adult↗
PubMed2002

Predicting chemotherapy response to paclitaxel-based therapy in advanced non-small-cell lung cancer (stage IIIb or IV) with a higher T stage (> T2). Technetium-99m methoxyisobutylisonitrile chest single photon emission computed tomography and P-glycoprotein express ion.

OBJECTIVE: The aim of this study was to compare technetium-99m methoxyisobutylisonitrile (Tc-MIBI) chest single photon emission computed tomography (SPECT) results, immunohistochemical analyses of P-glycoprotein (Pgp) expression and response to paclitaxel in non-small-cell lung cancer (NSCLC). METHODS: Before chemotherapy with paclitaxel, 30 patients with stage IIIb or IV NSCLC were enrolled in this study. Early chest SPECT was performed 10 min after intravenous injection of Tc-MIBI. Tc-MIBI chest SPECT images were qualitatively interpreted. Early tumor-to-normal lung ratios (T/NL) were calculated quantitatively. Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to determine Pgp expression. Chemotherapy response was evaluated in the third month after completion of treatment by clinical and radiological methods. RESULTS: All 15 (100%) cases with good response and negative Pgp expression had positive results of early Tc-MIBI chest SPECT. Ten of 15 (67%) cases with poor response and positive Pgp expression had negative results of early Tc-MIBI chest SPECT. These early T/NL ratios (3.3 +/- 0.8 for the 15 patients with good response and 2.0 +/- 0.2 for the 5 patients with poor response) in lung cancer could be detected on early Tc-MIBI chest SPECT. The difference was significant (p < 0.05) by an independent Student t test. However, no significant differences were found for other prognostic factors (age, sex, body weight loss, performance status, tumor cell type, and tumor stage) between the good and poor response groups. CONCLUSION: Early Tc-MIBI chest SPECT can be used to understand the Pgp expression in NSCLC and to quickly predict chemotherapy response to paclitaxel.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Sectorial technetium-99m-dimercaptosuccinic acid scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy for calyceal calculi on regional renal function.

OBJECTIVE: To apply a semiquantitative method for analysis of technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA) renal scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy (EPL) in patients with calyceal stones on regional kidney function and to check whether EPL had caused any deleterious effect on the target calyceal renal parenchymal function. PATIENTS AND METHODS: Forty patients (mean age 35 years) suffering from calyceal stones documented by abdominal plain radiography, intravenous urogram or abdominal ultrasound were studied. All patients were treated by EPL. (99m)Tc-DMSA scan was performed before and 4 weeks after EPL. Sector analysis involved calculation of the relative function of the target calyx to the function of the ipsilateral kidney and the relative function of the treated kidney to global renal function. RESULTS: The stone sizes were 6-11 mm in diameter and 11 were located in the upper, 13 in the middle and 16 in the lower calyx. After EPL, the overall stone clearance rate was 85% (100% for calculi in the upper and middle calyces, 62% for lower calyces). The sector analysis did not show statistically significant change of the relative regional (calyceal) or whole kidney function between the pre- and post-EPL (99m)Tc-DMSA scans. Using sector analysis, EPL appeared to be a safe modality and its usage was not associated with any untoward effect on calyceal or whole kidney function. CONCLUSION: Sector analysis of (99m)Tc-DMSA renal scan is a simple semiquantitative method for monitoring regional changes of kidney function after EPL for treatment of calyceal stone.

Adult↗
PubMedDate not supplied

Increased lung uptake of technetium-99m hexamethylpropylene amine oxime in diffuse infiltrative lung disease.

BACKGROUND: Diffuse infiltrative lung disease (ILD) is a heterogeneous group of disorders which predominantly affect the lung parenchyma and spare the airway. OBJECTIVE: To assess pulmonary vascular endothelium damage in ILD, the lung uptake of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) was determined. METHODS: In 20 ILD patients and 25 controls without ILD, the lung uptake of 99mTc-HMPAO was measured. Anterior lung imaging, including a large part of the liver, was made 10 min after intravenous injection of 20-25 mCi of 99mTc-HMPAO. Regions of interest covered the liver and lung to calculate the lung/liver uptake ratios. The 20 ILD patients included 10 patients with clinically manifest pulmonary disease (group 1) and 10 asymptomatic patients (group 2). All of the study subjects had normal pulmonary function test results. RESULTS: The mean lung/liver uptake ratio in the 25 controls without ILD (0.36 +/- 0.10) was significantly lower than that in the 20 ILD patients (0.97 +/- 0.61). In addition, the mean lung/liver uptake ratio in the 10 ILD patients with clinically manifest pulmonary disease (1.45 +/- 0.51) was higher than that of the other 10 asymptomatic ILD patients (0.49 +/- 0.09). CONCLUSIONS: Our results indicated that determining the lung/liver uptake ratio on 99mTc-HMPAO lung imaging should be an objective method to assess subclinical pulmonary damage in ILD patients.

Adult↗
PubMed1988

Single photon emission computed tomography with technetium-99m hexamethyl propylenamino oxime in the clinical assessment of cerebral ischemia. A preliminary evaluation.

94 subjects, 64 with cerebral ischemia of varying severity and outcome, and 30 controls were studied with technetium-99m hexamethyl propylenamino oxime single photon emission computed tomography in order to evaluate the suitability of this technique in the assessment of cerebral ischemia. Decreased uptake corresponding to the side of clinical symptomatology and/or to CT lesion was found in 93% of the patients with complete stroke and in 28% of the patients with transient ischemic attack. This procedure can be a useful tool in the routine examination of ischemic patients, although the mechanism underlying brain uptake is far from being completely understood and the possible quantitative evaluation of regional cerebral blood flow is worthy of further assessment.

Brain Ischemia↗
PubMed1993

Regional cerebral blood flow in multiple sclerosis measured by single photon emission tomography with technetium-99m hexamethylpropyleneamine oxime.

The regional cerebral blood flow (rCBF) in 19 patients with multiple sclerosis (MS), 10 with a relapsing remitting course and 9 with a progressive course, was examined by single photon emission computed tomography (SPECT) using technetium-99m hexamethylpropyleneamine oxime ([99mTc]-d,l-HM-PAO) as flow tracer. Nine age-matched volunteers served as controls. Low rCBF in the frontal grey matter correlated with neurological disability (p < 0.01), low frontal grey and white matter perfusion correlated with impaired cognitive functions (p < 0.02), and low rCBF in the occipital regions correlated with impaired visual functions (p < 0.03) in the MS population. A relationship was also found between reduced parietal white matter perfusion and the duration of the disease (p < 0.005). Patients with progressive MS had significantly reduced rCBF in the frontal grey matter compared with relapsing remitting MS patients and controls (p < 0.05). No other rCBF differences were found. As a diagnostic tool in MS, SPECT-[99mTc]-d,l-HM-PAO was found to be insensitive.

Adult↗
PubMed1993

Early hypoperfusion of technetium-99m hexamethylprophylene amine oxime brain single photon emission computed tomography in a patient with carbon monoxide poisoning.

Single photon emission computed tomography (SPECT) with technetium-99m (99mTc) hexamethylprophylene amine oxime (HM-PAO) were repeatedly performed in a 55-year-old woman with carbon monoxide (CO) poisoning. The initial brain SPECT 10 days after anoxic insult showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae, and the findings of follow-up SPECTs correlated with the clinical course of CO poisoning. The possibilities of early hypoperfusion on SPECT of acute CO poisoning were discussed.

Basal Ganglia↗
PubMed1995

Evaluation of outcome of delayed neurologic sequelae after carbon monoxide poisoning by technetium-99m hexamethylpropylene amine oxime brain single photon emission computed tomography.

Using brain computed tomography (CT) and single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc HM-PAO) in 13 patients with delayed neurologic sequelae after carbon monoxide poisoning, we tried to evaluate the clinical outcome of delayed CO sequelae. Among the 13 initial brain CTs, seven showed low density in the cerebral white matter and one revealed hypodensity in both globi pallidi. Of the 7 follow-up CT scans, 3 have remained unchanged, but in 4 cases more aggravating patterns with cortical atrophy without the clinical correlation were observed. There was no correlation between the CT findings and the outcome of delayed CO sequelae. All initial SPECTs in 13 patients with delayed CO sequelae showed diffuse patchy hypoperfusion throughout the cerebral cortex. Among the follow-up SPECTs in 7 patients, 6 patients showed increased cerebral perfusion with the concomitant clinical improvement, but the SPECT of a patient in bedridden state had remained unchanged, compared with the initial SPECT. There seemed to be good correlation between the findings of SPECT and the outcome of delayed CO sequelae. In conclusion, 99mTc HM-PAO brain SPECT is more sensitive than CT, and may be a useful test in evaluating the clinical outcome of delayed neurologic sequelae after CO poisoning.

Adult↗
PubMed1992

Acutely administered haloperidol-induced pattern changes of regional cerebral blood flow in schizophrenics. Observation from subtraction of brain imaging with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime.

Changes in regional cerebral blood flow in brain images with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime before and after intramuscular injection of haloperidol (0.08 mg/kg) were studied in 5 medicated subjects in their twenties, consisting of 5 schizophrenics and 1 patient with histrionic personality disorder, by a subtraction method of brain images. The haloperidol injection induced two types of perfusion pattern change; in 2 of the schizophrenics, a relative hypoperfusion in the frontal lobes in the images prior to injection was converted to a relative hyperperfusion. In the other 3 schizophrenics and in the patient with histrionic personality disorder, the slight left hemispheric dominance was changed to a marked right hemispheric dominance. The results indicate that haloperidol affects perfusion patterns in schizophrenics.

Acute Disease↗
PubMed1992

Widespread reduction of regional cerebral blood flow during hyperventilation-induced EEG slowing ('buildup'). Observation from subtraction of brain imaging with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime.

To study the pathophysiological mechanisms of hyperventilation-induced EEG showing, i.e., the so-called 'buildup' phenomenon, changes in regional cerebral blood flow (rCBF) were investigated before and during the phenomenon in a 16-year-old woman with headache, thought to be of neurotic origin, by subtraction technique of brain images with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime (99mTc-HMPAO). The tracer uptake during buildup decreased by 31-42% as compared to baseline values at rest before buildup in all of the measured regions, reflecting a widespread reduction in rCBF. Gas analyses of arterial blood collected during buildup showed a decrease in PaCO2, and increases in PaO2 and pH with a slight decrease in blood pressure and an increase in pulse rate. These results directly demonstrate a close correlation between the hyperventilation-induced EEG and rCBF changes, suggesting that the buildup phenomenon results from cerebral ischemic change, presumably due to cerebral vasoconstriction caused by the PaCO2 decrease.

Adolescent↗
PubMedDate not supplied

Acutely administered haloperidol-induced widespread reduction of regional cerebral blood flow observed from subtraction of brain imaging with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime.

Changes in brain images with single photon emission computed tomography (SPECT) using technetium-99m hexamethyl-propyleneamine oxime (99mTc HMPAO) before and after intramuscular injection of haloperidol (0.08 mg/kg) were studied in 2 unmedicated schizophrenic patients and 2 normal controls by a new technique, i.e. subtraction of brain images. The haloperidol injection reduced regional cerebral blood flow extensively in the bilateral cerebral hemispheres in one of the schizophrenics and one of the normal controls, with little or no haloperidol-induced effects in the remaining 2 subjects. The widespread cortical reduction is considered to be due to a nonspecific or indirect effect of haloperidol in view of the broad action sites inconsistent with the known anatomy of the mesocortical dopaminergic system.

Acute Disease↗
PubMed1977

Technetium-99m stannous pyrophosphate myocardial scintiphotos in patients admitted to rule out acute myocardial infarction.

Technetium-99m stannous pyrophosphate (Tc-PYP) cardiac scintiphotos were performed on 101 of 221 patients admitted to the Coronary Care Unit to rule out acute myocardial infarction (AMI). Criteria were defined for the diagnosis of AMI, variant angina and unstable angina. 42 patients were diagnosed as having had an AMI. 22 patients had transmural and 20 patients had nontransmural AMI. 40 of the 42 patients with AMI (95%) had positive scintophotos; 2 (5%) had negative scintiphotos. 59 patients did not have an AMI; (97%) had negative scintiphotos. Four of these 59 patients had variant angina; all had negative scintiphotos. Seven of these 59 patients had unstable angina; 2 had positive scintiphotos. Tc-PYP scintiphotos have high sensitivity and specificity and are accurate in correctly classifying patients as having or not having AMI.

Acute Disease↗
PubMed1992

Kinetics of technetium-99m-Sestamibi and thallium-201 in a transient ischemic myocardium animal model: insight into the 'redistribution' phenomenon.

This study was designed to determine the redistribution potential for technetium-99m (99mTc)-hexakis-2-methoxy isobutyl isonitrile (99mTc-Sestamibi) as compared to thallium-201 (201Tl) in a transiently ischemic swine heart model. The left anterior descending coronary artery (LAD) was totally occluded for 10 min. One minute prior to the release of the LAD, 99mTc-Sestamibi, 201Tl and a set of 95Nb-radiolabeled microspheres (15 microns) were injected. A second set of 51Cr-radiolabeled microspheres was injected prior to sacrifice in order to document reflow. Animals were sacrificed at different times post-LAD release (ranging from 1 min to 4 h). The left ventricle was sectioned into 0.2- to 0.5-gram pieces for the gamma spectroscopic counting of the 99mTc-Sestamibi, 201Tl and radiolabeled microspheres. Linear regression analysis of radiotracer localization versus microsphere-determined regional myocardial blood flow (rMBF) demonstrates an initial slight filling in of 99mTc-Sestamibi into transiently ischemic zones, with subsequent stable kinetics up to 4 h (i.e., it does not further redistribute). In comparison, the ischemic to normal ratios for 201Tl activity increase progressively in a time-dependent manner. These differences between 99mTc-Sestamibi and 201Tl might be explained on the basis of their blood clearance kinetics and/or their net clearance from normal and ischemic zones of the heart. It is concluded that 99mTc-Sestamibi is a stable and reliable indicator for rMBF over time, and that the lack of normalization of 99mTc-Sestamibi into transient ischemic zones will necessitate two separate injections for differentiation between ischemia and persistent defects.

Animals↗
PubMed1984

Technetium 99m autoradiography of labelled white cells.

The cellular uptake of technetium 99m was determined on white blood cells (WBC) by autoradiography, after 'cold' tin pyrophosphate prelabelling followed by pertechnetate labelling. The autoradiographic method gave visible tracks of 99mTc internal conversion and Auger electrons. 75 +/- 5% of the treated WBC were labelled but none of the control WBC. The number and length of tracks per cell varied greatly. This was perhaps due to imaging conditions as well as to variations in cell uptake.

Autoradiography↗
PubMed1989

[Successful immunoscintigraphic tumor detection with technetium 99m marked monoclonal anti-CEA antibodies].

Twenty patients aged 32-76 years (median 56 years) with various primary cancers or tumor recurrences (colorectal n = 14; lung, breast, medullary thyroid carcinoma n = 2, each) were studied with a technetium-99m labeled anti-CEA antibody. Intact monoclonal antibody BW 431/26 (Scintimum CEA-Tc-99m, Behringwerke AG, Marburg) was successfully labeled (Schwarz Method) by an instant 2-vial kit (labeling efficiency greater than 95% (TLC, HPLC), preserved immunoreactivity). The most frequent clinical indications were (1) the detection of tumor recurrences in patients with a steadily increasing serum CEA level (at a mean 2.3 years after complete removal of the primary tumor) but normal findings by conventional imaging modalities, (2) the search for extrahepatic tumor involvement in patients with known liver metastases scheduled for regional chemotherapy. Gamma camera scintigrams (planar and ECT) were performed 6-12 h and 18-26 h postinjection yielding a sensitivity of 95% (positive tumor contrast in 19/20 patients) with a specificity of 90% (positive predictive value 95%). Immunoscintigraphy successfully depicted tumor recurrences in 4/6 patients with elevated serum CEA values where all conventional imaging modalities had failed. The successful labeling of monoclonal antibodies with 99mTc represent an important step in clinical progress for the more practically orientated use of immunoscintigraphy and also opens new diagnostic fields.

Adult↗
PubMed1975

Acute subendocardial myocardial infarction in patients. Its detection by Technetium 99-m stannous pyrophosphate myocardial scintigrams.

Eighty-eight patients admitted to a coronary care unit with chest pain of varying etiology but without ECG evidence of an acute transmural myocardial infarction had myocardial scintigrams using technetium-99m stannour pyrophosphate (99m-Tc-PYP). Seventeen of these patients had ECG and enzymatic evidence suggestive of acute subendocardial myocardial infarction. In each of these the scintigrams were postivie demonstrating increased 99m-Tc-PYP uptake either in a faintly but diffusely positive pattern or in a well-localized strongly positive one. The remaining 71 patients did not evolve ECG or enzymatic evidence of acute myocardial infarction. In each of these patients the myocardial scintigram was negative. Thus 99m-Tc-PYP myocardial scintigrams are capable of identifying the presence of acute subendocardial myocardial infarction in patients. The absolute frequency with shich subendocardial myocardial infarction can be recognized utilizing this technique will have to be established in a larger number of patients in the future.

Acute Disease↗
PubMed1975

Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs.

To obtain insight into the mechanism(s) responsible for the direct visualization of acute myocardial infarcts by myocardial scintigraphy with technetium-99m stannous pyrophosphate (99mTc-PYP), scintigraphic and morphologic studies were performed in 22 dogs subjected to occlusion of the proximal left anterior descending coronary artery (LAD). Grossly visible myocardial infarcts occurred in ten of 11 dogs with LAD occlusion for one day, five with LAD occlusion for two days, two with LAD occlusion for seven days and two with LAD occlusion for 13 days. Rare, microscopic foci of necrosis were observed in one dog with LAD occlusion for one day, and no lesions were present in two dogs subjected to temporary LAD occlusion for eight minutes and reflow for 24 hours. In the latter three dogs, 99mTc-PYP myocardial scintigrams were negative. In the 19 dogs with gross infarcts, 99mTc-PYP myocardial scintigrams were strongly positive at one and two days after LAD occlusion, much less positive at seven days and faintly positive at 13 days after occlusion. Positive myocardial scintigrams in most showed "doughnut" patterns, with marked peripheral concentration of radioactivity around central zones of much lower activity. On histologic examination, the one and two-day-old infarcts exhibited subendocardially located central zones and surrounding peripheral zones, both of which showed distinctive histopathological and histochemical features, including the selective occurrence in the peripheral zones of calcified muscle cells with ultrastructurally demonstrable apatite-like crystals in mitochondria. Selective occurrence of high tissue levels of 99mTc-PYP radioactivity also was demonstrated in the peripheral zones of four infarcts. Hearts with older infarcts (seven and 13 days) showed progressive replacement of necrotic myocardium by granulation tissue and progressive reduction in calcium deposits in the areas of damage. The data obtained in this study establish a temporal and topographical relationship between calcium accumulation in acute myocardial infarcts and 99mTc-PYP uptake responsible for scintigraphic detection of the lesions with this radionuclide in dogs subjected to proximal LAD occlusion.

Acute Disease↗